U.S. patent application number 14/538310 was filed with the patent office on 2015-03-05 for patient positioning support structure.
The applicant listed for this patent is Roger P. Jackson. Invention is credited to Roger P. Jackson.
Application Number | 20150059094 14/538310 |
Document ID | / |
Family ID | 52581135 |
Filed Date | 2015-03-05 |
United States Patent
Application |
20150059094 |
Kind Code |
A1 |
Jackson; Roger P. |
March 5, 2015 |
PATIENT POSITIONING SUPPORT STRUCTURE
Abstract
A patient support system includes independently adjustable end
columns supporting a centrally hinged, jointed or breaking patient
support structure. At least one column includes a powered rotation
assembly. The patient support includes at least two sections. A
coordinated drive system provides for both upwardly and downwardly
breaking or jointed orientations of the two sections in various
inclined and tilted positions. Cable, cantilevered and pull-rod
systems are included.
Inventors: |
Jackson; Roger P.; (Prairie
Village, KS) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Jackson; Roger P. |
Prairie Village |
KS |
US |
|
|
Family ID: |
52581135 |
Appl. No.: |
14/538310 |
Filed: |
November 11, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14096875 |
Dec 4, 2013 |
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14538310 |
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13317012 |
Oct 6, 2011 |
8719979 |
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14096875 |
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12460702 |
Jul 23, 2009 |
8060960 |
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13317012 |
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11788513 |
Apr 20, 2007 |
7565708 |
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12460702 |
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11159494 |
Jun 23, 2005 |
7343635 |
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11788513 |
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11062775 |
Feb 22, 2005 |
7152261 |
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11159494 |
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14050998 |
Oct 10, 2013 |
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11062775 |
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13317012 |
Oct 6, 2011 |
8719979 |
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14050998 |
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14051155 |
Oct 10, 2013 |
8684865 |
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13317012 |
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13317012 |
Oct 6, 2011 |
8719979 |
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14051155 |
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60798288 |
May 5, 2006 |
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Current U.S.
Class: |
5/608 ;
5/610 |
Current CPC
Class: |
A61B 6/0407 20130101;
A61G 13/0036 20130101; A61G 7/001 20130101; A61G 13/06 20130101;
A61G 2200/325 20130101; A61G 13/02 20130101; A61G 13/0054 20161101;
A61G 13/04 20130101; A61G 13/08 20130101; A61G 13/104 20130101;
A61G 7/008 20130101 |
Class at
Publication: |
5/608 ;
5/610 |
International
Class: |
A61G 13/04 20060101
A61G013/04; A61G 13/06 20060101 A61G013/06 |
Claims
1. An apparatus for supporting and positioning a patient during a
surgical procedure, comprising: a) a breaking patient support
structure with first and second frame portions joined by an
articulation; and b) a surgical table base that includes first and
second base structures, wherein: i) the first base structure is
attached to the first frame portion and actively longitudinally
translated the patient support structure, whereby the first base
structure operably raises, tilts and inclines the patient support
structure; and ii) the second base structure is attached to the
second frame portion such that the patient support structure is
passively longitudinally translated.
2. The apparatus according to claim 1, including: a) a translation
connector, a connection pin and a pivot pin; wherein b) the
connection pin engages the translation connector and the patient
support structure, whereby the translation connector and the
patient support structure are pivotably joined together; c) the
pivot pin engages the translation connector and an angulation
subassembly, whereby the translation connector and the angulation
subassembly are pivotably joined together; and d) a distance
between the connection pin and the pivot pin, the distance varying
in cooperation with positioning of the patient support
structure.
3. The apparatus according to claim 2, wherein: a) the first base
structure includes a vertically adjustable pier including the
angulation subassembly and a rotation subassembly, the pier
cooperating with the surgical table base to position the patient
support structure in a plurality of selectable positions.
4. The apparatus according to claim 1, wherein: a) first and second
frame portions each include an inner end, the inner ends being
joined by the articulation; and b) the articulation is
substantially longitudinally stationary during the position the
patient support in a plurality of selectable positions.
5. The apparatus according to claim 4, wherein: a) the articulation
includes a pair of spaced apart hinges.
6. An apparatus for supporting and positioning a patient during a
surgical procedure, comprising: a) a pair of translation
connectors, each of the translation connectors being located
between a respective outer end of a patient support structure and a
respective vertically adjustable pier of a base; wherein b) a first
of the translation connectors is non-slidably fixed directly to the
patient support structure, such that the first translation
connector and the patient support structure are in non-slidable
relationship to one another.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S. Ser. No.
14/096,875, filed Dec. 4, 2013, and which is a continuation of U.S.
Ser. No. 13/317,012, filed Oct. 6, 2011, now U.S. Pat. No.
8,719,979, all of which are incorporated by reference herein. U.S.
Ser. No. 13/317,012 is a continuation of U.S. Ser. No. 12/460,702,
filed Jul. 23, 2009, now U.S. Pat. No. 8,060,960, which is a
continuation of U.S. Ser. No. 11/788,513, filed Apr. 20, 2007, now
U.S. Pat. No. 7,565,708, which claimed the benefit of U.S.
Provisional Application No. 60/798,288 filed May 5, 2006 and was
also a continuation-in-part of pending U.S. patent application Ser.
No. 11/159,494 filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635,
that is a continuation-in-part of U.S. patent application Ser. No.
11/062,775 filed Feb. 22, 2005, now U.S. Pat. No. 7,152,261, all of
which are incorporated by reference herein. This application is a
continuation-in-part of U.S. Ser. No. 14/050,998, filed Oct. 10,
2013, and which is a continuation-in-part of U.S. Ser. No.
13/317,012, filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, all of
which are incorporated by reference herein. This application is
also a continuation-in-part of U.S. Ser. No. 14/051,155, filed Oct.
10, 2013, and which is a continuation of U.S. Ser. No. 13/317,012,
filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, all of which are
incorporated by reference herein.
BACKGROUND OF THE INVENTION
[0002] The present invention is directed to structure for use in
maintaining a patient in a desired position during examination and
treatment, including medical procedures such as imaging and surgery
and in particular to such a structure that allows a surgeon to
selectively position the patient for convenient access to the
surgery site and providing for manipulation of the patient during
surgery including the tilting, pivoting, angulating or bending of a
trunk and/or a joint of a patient in a supine, prone or lateral
position.
[0003] Current surgical practice incorporates imaging techniques
and technologies throughout the course of patient examination,
diagnosis and treatment. For example, minimally invasive surgical
techniques, such as percutaneous insertion of spinal implants,
involve small incisions that are guided or navigated by continuous
or repeated intra-operative imaging requiring patient positioning
for image registration and navigation. These images can be
processed using computer software programs that produce three
dimensional images for reference by the surgeon during the course
of the procedure. If the patient support structure having an open
frame or a flat top surface is not radiolucent or compatible with
these imaging technologies, it may be necessary to interrupt the
surgery periodically in order to remove the patient to a separate
patient support structure for imaging followed by transfer back to
the operating support surface for resumption of the surgical
procedure. Such patient transfers for imaging purposes may be
avoided by employing radiolucent and other imaging compatible
patient support systems. The patient support system should also be
constructed to permit unobstructed movement of the imaging
equipment and other surgical equipment around, over and under the
patient throughout the course of the surgical procedure without
contamination of the sterile field and without pulling out tubes
and lines.
[0004] It is also necessary that the patient support system be
constructed to provide optimum access to the surgical field by the
surgery team. Some procedures require positioning of portions of
the patient's body in different ways at different times during the
procedure. Some procedures, for example, spinal surgery, involve
access through more than one surgical site or field. Since all of
these fields may not be in the same plane or anatomical location,
the patient support structures should be adjustable and capable of
providing support in different planes for different parts of the
patient's body as well as different positions or alignments for a
given part of the body. Preferably, the support structure should be
adjustable to provide support in separate planes and in different
alignments for the head and upper trunk portion of the patient's
body, the lower trunk and pelvic portion of the body as well as
each of the limbs independently.
[0005] Certain types of surgery, such as orthopedic surgery, may
require that the patient or a part of the patient be repositioned
during the procedure while in some cases maintaining the sterile
field. Where surgery is directed toward motion preservation
procedures, such as by installation of artificial joints, total
disc prostheses and soft and dynamic stabilization system, for
example, the surgeon must be able to manipulate certain joints
while supporting selected portions of the patient's body during
surgery in order to facilitate the procedure. It is also desirable
to be able to test the range of motion of the surgically repaired
or stabilized joint and to observe the gliding movement of the
reconstructed articulating prosthetic surfaces or the tension and
flexibility of spacers and other types of elastic or dynamic
stabilizers before the wound is closed. Such manipulation can be
used, for example, to verify the correct positioning and function
of an implanted prosthetic disc, spinal dynamic longitudinal
connecting member, interspinous spacer or joint replacement during
a surgical procedure. Where manipulation discloses binding,
sub-optimal position or even crushing of the adjacent vertebrae,
for example, as may occur with osteoporosis, the prosthesis can be
removed and the adjacent vertebrae fused while the patient remains
anesthetized. Injury which might otherwise have resulted from a
"trial" use of the implant post-operatively will be avoided, along
with the need for a second round of anesthesia and surgery to
remove the implant or prosthesis and perform the revision, fusion
or corrective surgery.
[0006] There is also a need for a patient support structure that
can be rotated, angulated, articulated and translated so that the
patient can be moved from a prone to a supine position or from a
prone to a 90.degree. position and whereby intra-operative
extension and flexion of at least a portion of the spinal column
can be achieved. The patient support structure must also be capable
of easy, selective adjustment without necessitating removal of the
patient or causing substantial interruption of the procedure.
[0007] For certain types of surgical procedures, for example spinal
surgeries, it may be desirable to position the patient for
sequential anterior and posterior procedures. The patient support
structure should also be capable of rotation about an axis in order
to provide correct positioning of the patient and optimum
accessibility for the surgeon as well as imaging equipment during
such sequential procedures.
[0008] Orthopedic procedures may also require the use of traction
equipment such as cables, tongs, pulleys and weights. The patient
support system must include structure for anchoring such equipment
and it must provide adequate support to withstand unequal forces
generated by traction against such equipment.
[0009] Articulated robotic arms are increasingly employed to
perform surgical techniques. These units are generally designed to
move short distances and to perform very precise work. Reliance on
the patient support structure to perform any necessary gross
movement of the patient can be beneficial, especially if the
movements are synchronized or coordinated. Such units require a
surgical support structure capable of smoothly performing the
multi-directional movements which would otherwise be performed by
trained medical personnel. There is thus a need in this application
as well for integration between the robotics technology and the
patient positioning technology with synchronization by software
programs.
[0010] While conventional operating tables generally include
mechanisms that permits tilting or rotation of a patient support
structure about a longitudinal axis, previous surgical support
devices have attempted to address the need for unrestricted access
by providing a cantilevered patient support structure on one end of
a base. Such designs typically employ either a massive base to
counterbalance the extended support member or a large overhead
frame structure to provide support from above. The enlarged base
members associated with such cantilever designs can be problematic
with respect to the movement of C-arm, CT scanners and O-arm mobile
fluoroscopic imaging devices as well as other equipment. In
addition, their patient support structures have not provided for
much articulation or flexion and extension of the patient being
supported. Surgical tables with overhead frame structures are bulky
and may require the use of dedicated operating rooms, since in some
cases they cannot be moved easily out of the way. Neither of these
designs is easily portable or storable.
[0011] Thus, there remains a need for a patient support system that
provides easy access for personnel and equipment, that can be
easily and quickly positioned and repositioned in multiple planes
without the use of massive counterbalancing support structure, and
that does not require use of a dedicated operating room. In this
regard, providing support on both outer ends of the patient support
structure suspended therebetween can provide some advantages as
further outlined herein.
SUMMARY OF THE INVENTION
[0012] Prior developments for surgical tables have provided a
patient support structure having one or more inward articulations
that allow for the support structure to break or angulate. The
articulation typically occurs between a head end section and a foot
end section of the support structure. The articulation can have a
virtual pivot axis, an actual pivot axis or a point along one of
these axes. The articulation having a virtual pivot axis keeps the
gap between the inner ends of the head and foot end sections or
portions a fixed distance apart while they are being articulated
into a flexed or extended position or orientation. Such an
arrangement has several advantages in that the virtual pivot axis
can be entirely radiolucent and it does not directly need to carry
or support any load. Binding at the articulation is also not a
concern when the outer ends of the head and foot sections,
connected to a base, are at different elevations above the floor
and the patient support structure itself is rolled or tilted.
Load-sharing for this type of articulated patient support structure
is concentrated or its outer ends connected to the base by a
connection assembly providing rotation structures, angulation or
pivot structure and translation compensation structure within the
connection assembly between the base and the outer ends of the
patient support structure.
[0013] The patient support structure having an inward articulation
with an actual pivot axis can have a pin about which angulation
occurs. Again, the inner ends of the head and foot end section
remain a fixed distance apart during the angulation at this inward
articulation. This articulation is typically a hinge or joint
structure. The hinge or joins structure can extend across the
patient support structure or preferably be a pair of spaced apart
hinges or joints. This articulation can also be radiolucent. It can
participate in load-sharing equally with the outer ends of the
patient support structure connected to the base by a connection
assembly, or it can remain relatively unloaded while the
load-sharing is done at said outer ends. This inward articulation
can have an actuator that directly or indirectly moves it. The
actuator can be located at or near the articulation or at to near
the connection assembly between the base and the outer end or ends
of the patient support structure. In either case, direct vertical
structural support at both outer ends of the patient support
structure is fundamental for the surgical table embodiments
disclosed in this application. This occurs through multi-functional
connection assemblies at both outer ends of the patient support
structure.
[0014] While manipulation of the patient when on the support
structure suspended between outer end supports of the base is
desirable, too much vertical and horizontal travel for the patient
is not, as this can lead to unwanted consequences concerning
anaesthesia, tubing, IV lines in the patient, and son on. Having
translation occur at or near both outer ends of the patient support
structure can help minimize at least the horizontal travel that
might otherwise need to occur at or around the inward
articulations, especially with breaking or angulation for patient
positioning and during patient manipulations. This translation at
both outer ends of the patient support structure can occur in
different ways. For example, both outer ends of the patient support
structure and the base end supports can translated inwardly
simultaneously so as to keep the articulation from moving very much
horizontally with angulation thereabout. This is generally
favorable for the surgeon, but may not be for other members of the
surgical team.
[0015] Another way this necessary translation can occur is by dual
translation connector mechanisms at both outer ends of the patient
support structure, wherein the base end supports do not need to
travel along the floor. The translation connectors can have
activators or not, and the actuators can also provide for
angulation and rotation at the connection assemblies between the
base and the outer end of the patient support structure. When the
actuators provide for the angulation between the base and the
patient support structure at its outer ends, the inward
articulations for the patient support structure need not carry much
load. This allows for the hinge or joint mechanism to be fairly
simple, wherein it can have a radiolucent pin about which the
angulation can occur. Again, the connection assemblies between the
outer ends of the patient support structure and the base can
include horizontal translation connector subassemblies, in addition
to powered mechanisms for angulation and rotation and in some cases
even vertical translation for height adjustment above the
floor.
[0016] The translation connectors in the different table
embodiments disclosed herein can also have a plurality of
rotational or pivot axes, wherein the axes can translated
horizontally with respect to each other. For example, a transverse
axis of rotation can be located at or between the attachment of the
translation connector mechanism to the end support of the base and
a perpendicular axis of rotation can be located at or between the
attachment of the translation connector mechanism to the outer end
of the patient support structure. In this way, the translation
connector mechanism can provide for at least two degrees of freedom
for rotational movement between the outer ends of the patient
support structure and the base, which is necessary when the patient
support structure inward articulation is angulated and rolled, fore
example. The roll can occur at the translation connector mechanism,
at its outer end attachments or somewhere else in the connecting
assembly, such as at the top of the base end supports. In this
regard, the various structural components of the connection
assemblies can be completely or partially powered.
[0017] Therefore, the present invention is directed to patient
support systems that permit adjustable positioning, repositioning
and selectively lockable support of a patient's head and upper
body, lower body and limbs in up to a plurality of individual
planes while permitting inclination, roll or tilting, rotation or
angulation, breaking or bending and other manipulations as well as
full and free access to the patient by medical personnel and
equipment. The system of the present invention may be cantilevered,
wherein load-sharing is primarily at the outer end of the patient
support structure, or non-cantilevered and include a pair of spaced
apart support ends, piers or columns that are each height
adjustable. The illustrated embodiments include a pair of opposed
independently height-adjustable end support columns. The columns
may be independent or connected to a horizontally length-adjustable
base in one embodiment. One support column according to the
invention may be coupled with a wall mount or other stationary
support. In each case, a patient support structure is connected to
and bridges substantially between the pair of end supports. For
example, in a preferred embodiment according to the invention, the
patient support structure is hingedly suspended between the end
supports.
[0018] The patient support structure may be a frame or other
patient support that is semi-constrained, having at least first and
second hingeable or otherwise joined or connected portions or
sections, the first and second portions being selectively lockable
in a first substantially planar orientation along a longitudinal or
horizontal axis of the support structure that resembles
conventional constrained or fixed patient support structures.
However, the hinged or semi-constrained support structure of the
invention provides for the first and second portions that are also
positionable and lockable in a plurality of angles with respect to
one another, with each portion being movable to a position on
either side of the first planar orientation. In other words, the
patient support structure is capable of articulating, hinging or
otherwise bending to form an angulation, break or joint, either
upwardly or downwardly from a vertical starting position above the
floor and also when the support structure is in an inclined or
declined position due to one of the support columns raising one end
of the structure higher than another end. Furthermore, in addition
to an "up" or "down" break, such a break or joint created by the
two portions may be oriented from side-to-side, as when the support
structure is rolled or rotated about a longitudinal axis
thereof.
[0019] In a particular illustrated embodiment, articulation,
jointing or breaking of the patient support structure at an inward
or central location between the pair of stationary end supports is
supported by a cable drive system (tension band suspension). The
tension band structure can be metal or radiolucent polymer. In
another embodiment, a pull-rod assembly supports articulation to
control the break or articulation angle and render the patient
support structure rigid. Again, the pull-rod can be radiolucent.
Such an embodiment further includes a substantially fixed slider
bar disposed at an end of the patient support, the patient support
structure being supported by and slidingly movable along such
slider bar with the bar following the angle of inclination of the
patient support at such end. Other embodiments include cantilevered
systems with connected or unconnected movable or translating base
supports. The first and second patient support structure portions
may be in the form of frames, such as rectangular frames or other
support structure that may be equipped with support pads for
holding the patient, or other structure, such as imaging tops which
provide a flat radiolucent surface.
[0020] The patient support structure and the base support columns
are coupled or connected with respective roll or rotation,
articulation, pivot or angulation adjustment and horizontal
translation structures in the form of connection and assemblies for
positioning the first support portion with respect to a first
column or end support and with respect to the second support
portion and the second support portion with respect to the second
column or end support. Rotation adjustment structure in cooperation
with pivoting and height adjustment structure provided by the
connection assemblies allow for the lockable positioning of the
first and second patient support portions at a variety of selected
positions and articulations with respect to the support columns
including angulation or pivot coupled with Trendelenburg and
reverse Trendelenburg configurations as well as providing for
patient roll over in horizontal or tilted orientation. Lateral
movement or translation (toward and away from a surgeon) and
longitudinal translation may also be provided by powered actuators
in the base end support columns. A pair of patient support
structures (such as a support frame and an imaging table) may be
mounted between end supports of the invention and then rotated in
unison about a longitudinal axis to achieve 180.degree.
repositioning of a patient, from a prone to a supine position in
some embodiments.
[0021] In another embodiment, an apparatus for supporting a patient
during a medical procedure is provided, the apparatus including a
base structure with first and second spaced opposed end supports;
each end support being attached to the base structure; an elongate
patient support structure including first and second portions
joined inwardly at an articulation, the patient support structure
outwardly connected to the end supports by connection assemblies
and being alignable in a first plane and movable to a plurality of
angular orientations with respect to one another on either side of
the first plane; the inward articulation joining the first and
second portions and movable to a plurality of angular orientations
associated with the angular orientations of the outwardly connected
ends of the patient support structure relative to the end supports
and a translation connector subassembly connecting each outer end
of the patient support structure to the base and cooperating with
the inward articulation and outwardly connected ends of the patient
support structure, as a component of the connection assemblies, so
as to allow the patient support structure to move through the
various angular orientations thereof without the spaced opposed end
supports moving relative to each other with respect to a spaced
opposed distance; and a structure to move the articulation into the
various angular orientations.
[0022] In a further embodiment, at least one of the end supports
includes a first vertical height adjustor and a second vertical
height adjustor is positioned between the spaced opposed end
supports.
[0023] In a further embodiment, a single translation connector
subassembly can be used in the form of a slider bar, rigidly
attached to one outer end of the first and second portions, the
slider bar pivotally attached with transverse and perpendicular
axes to one of the end supports and providing a large amount of
translation at one end of the table so as to make up for not having
translation at the opposed or opposite end.
[0024] In a further embodiment, at least one of the end supports
further includes a rotation mechanism.
[0025] In a further embodiment, the patient support structure is
detachable and positionable at either end in a plurality of
locations vertically spaced from a floor.
[0026] In a further embodiment, the articulation has a hinge or
joint mechanism, load-sharing and not, that cooperates with the
various angular orientations.
[0027] Yet another embodiment provides an apparatus for supporting
a patient during a medical procedure, including a support
subassembly including first and second spaced opposed upright end
supports; each end support being attached to a respective base
structure; at least one of the first and second end supports being
vertically height adjustable; an elongate patient support with
first and second ends and extending between the first and second
end supports; the patient support being held by the end supports in
spaced relation with respect to a floor, the patient support
connected to and supported between the end supports; the patient
support having a single breaking location spaced from the end
supports and adapted to interact with the patient when the patient
is located on the patient support; and a vertical elevator
connecting a patient support first end with a respective end
support; the vertical elevator being controllable to allow
continuous non-segmented adjustment of the support first end
relative to the respective end support so as to align and orient
the patient support subassembly; and wherein the patient support is
controllable to be upwardly and downwardly articulatable at both
the first and second ends of the patient support relative to
respective end supports and at the breaking location so as to be
adapted to manipulate a patient into a plurality of selectively
prone and non-prone positions in cooperation with a pivoting end
support translation compensation mechanism at both outer ends of
the patient support structure, while also cooperating with the end
supports to move the patient between vertical positions.
[0028] Still another embodiment provides an apparatus for
supporting a patient during a medical procedure, the apparatus
including a support subassembly including first and second spaced
opposed end supports; each end support being attached to a
respective base structure; at least one of the first and second end
supports being vertically height adjustable; an elongate patient
support with first and second ends and extending between the first
and second end supports; the patient support being held by the end
supports in spaced relation with respect to a floor, the patient
support connected to and supported between the end supports; the
patient support having a single breaking location spaced from the
end supports and adapted to interact with the patient when the
patient is located on the patient support; and a vertical elevator
connecting a patient support first end with a respective end
support; the vertical elevator being controllable to allow
continuous adjustment of the support first end relative to the
respective end support so as to align and orient the patient
support subassembly; and wherein the patient support is
controllable to be upwardly and downwardly articulatable at both
the first and second ends of the patient support relative to
respective end supports and at the breaking location so as to be
adapted to manipulate a patient into a plurality of selectively
prone and non-prone positions in cooperation with a patient support
translation compensation mechanism at both outer ends thereof,
while also cooperating with the end supports to move the patient
between vertical positions, and wherein at least one translation
compensation mechanism is moved by an actuator in a longitudinal
direction.
Objects and Advantages of the Invention
[0029] Therefore, it is an object of the present invention to
overcome one or more of the problems with patient support systems
described above. Further objects of the present invention include
providing breaking or hinged patient support structures; providing
such structures wherein such break or joint may be in any desired
direction; providing such structures that include at least one base
support structure that allows for vertical height adjustment;
providing such a structure wherein such base support is located at
both outer ends of the patient support, allowing for patient
positioning and clearance for access to the patient in a wide
variety of orientations; providing such a structure that may be
rotated about an axis as well as moved upwardly or downwardly at
either end thereof; and providing apparatus and methods that are
easy to use and especially adapted for the intended use thereof and
wherein the apparatus are comparatively inexpensive to make and
suitable for use.
[0030] Other objects and advantages of this invention will become
apparent from the following description taken in conjunction with
the accompanying drawings wherein are set forth, by way of
illustration and example, certain embodiments of this
invention.
[0031] The drawings constitute a part of this specification and
include exemplary embodiments of the present invention and
illustrate various objects and features thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
[0032] FIG. 1 is a perspective view of a breaking patient support
structure according to the invention and having load-sharing hinges
and translation compensation mechanisms on both outer ends of the
patient support structure.
[0033] FIG. 2 is an enlarged and partial side elevational view of a
portion of the support structure of FIG. 1.
[0034] FIG. 3 is an enlarged and partial top plan view of the
support structure of FIG. 1.
[0035] FIG. 4 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1.
[0036] FIG. 5 is an enlarged and partial side elevational view of a
portion of the structure of FIG. 1 showing a translation connector
subassembly with longitudinally translating transverse and
perpendicular axes with respect to each other.
[0037] FIG. 6 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1.
[0038] FIG. 7 is an enlarged and partial perspective view of a
radiolucent first hinge of the structure of FIG. 1.
[0039] FIG. 8 is an enlarged and partial perspective view of a
cooperating radiolucent second hinge of the structure of FIG.
1.
[0040] FIG. 9 is an enlarged and partial elevational view of the
hinge of FIG. 7.
[0041] FIG. 10 is an enlarged and partial perspective view of an
outer portion of the hinge of FIG. 7 with portions broken away to
show the detail thereof.
[0042] FIG. 11 is an enlarged and partial perspective view of an
inner portion of the hinge of FIG. 7 with portions broken away to
show the detail thereof.
[0043] FIG. 12 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1 showing an actuator in the form
of a cable drive motor and winch cylinders.
[0044] FIG. 13 is a partial perspective view of a patient support
frame of the structure of FIG. 1.
[0045] FIG. 14 is a partial perspective view of a patient imaging
top for replacement with the patent support frame of FIG. 13.
[0046] FIG. 15 is a reduced perspective view of the structure of
FIG. 1 shown with an imaging top of FIG. 14 replacing the support
frame of FIG. 13 and shown in a planar inclined position.
[0047] FIG. 16 is a perspective view of the structure of FIG. 15
shown in a planar tilted position.
[0048] FIG. 17 is a perspective view of the structure of FIG. 15
shown in a planar inclined and tilted position.
[0049] FIG. 18 is a side elevational view of the structure of FIG.
15 shown in a symmetrical upward breaking position.
[0050] FIG. 19 is a side elevational view of the structure of FIG.
15 shown in a first inclined and upward breaking position.
[0051] FIG. 20 is a side elevational view of the structure of FIG.
15 shown in a second inclined and upward breaking position.
[0052] FIG. 21 is a side elevational view of the structure of FIG.
15 shown in a symmetrical downward breaking position.
[0053] FIG. 22 is a side elevational view of the structure of FIG.
15 shown in a first inclined and downward breaking position.
[0054] FIG. 23 is a side elevational view of the structure of FIG.
15 shown in a second inclined and downward breaking position.
[0055] FIG. 24 is an enlarged side elevational view of the
structure of FIG. 1 shown in an upward breaking, inclined and
tilted position.
[0056] FIG. 25 is a is a perspective view of a second embodiment of
a patient support structure according to the invention including a
patient support frame and an imaging table shown in a first spaced
orientation.
[0057] FIG. 26 is a perspective view of the patient support
structure of FIG. 25 shown tilted in an intermediate position
during a rotation as would be used for a patient rollover.
[0058] FIG. 27 is a perspective view of the structure of FIG. 25
shown further rolled or tilted in a second intermediate position
during rotation.
[0059] FIG. 28 is a perspective view of the structure of FIG. 25
shown after rotation to a final flipped position.
[0060] FIG. 29 is a perspective view similar to FIG. 25 showing the
articulating patient support frame and the articulating imaging
table in a second spaced orientation.
[0061] FIG. 30 is a front elevational view of a third embodiment of
a patient support structure according to the invention showing a
pair of opposed translating (inwardly and vertically) end supports
and a patient support structure articulation that does not share
much loading due to angulation actuators at both outer ends
thereof.
[0062] FIG. 31 is a front elevational view of a fourth embodiment
of a patient support structure according to the invention.
[0063] FIG. 32 is a perspective view of a fifth embodiment of a
patient support structure according to the invention, shown in a
planar inclined position, wherein the patient support structure
can, again, have translation compensation at both of its outer
ends.
[0064] FIG. 33 is a perspective view of the structure of FIG. 32
shown in an inclined and upward breaking position at an inward
articulation that is only partially load-sharing due to an
angulation actuator in one end of the base which carries most of
the weight when loaded.
[0065] FIG. 34 is a perspective view of the structure of FIG. 32
shown in a substantially symmetrical downward breaking
position.
[0066] FIG. 35 is a reduced side elevational view of a sixth
embodiment of a patient support structure having a load-sharing
inward articulation according to the invention shown in a
substantially horizontal and planar position and a large amount of
translation compensation available on only one outer end of the
support structure.
[0067] FIG. 36 is a reduced side elevational view of the structure
of FIG. 35 shown in a symmetrical downward breaking position.
[0068] FIG. 37 is a reduced side elevational view of the structure
of FIG. 35 shown in a symmetrical downward breaking position.
[0069] FIG. 38 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 35.
[0070] FIG. 39 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 35.
[0071] FIG. 40 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 35.
[0072] FIG. 41 is an enlarged and partial perspective view of the
structure shown in FIG. 40.
[0073] FIG. 42 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 36.
[0074] FIG. 43 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 36.
[0075] FIG. 44 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 36.
[0076] FIG. 45 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 37.
[0077] FIG. 46 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 37 and showing all of the translation compensation occurring
on the foot end of the patient support structure.
[0078] FIG. 47 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 37.
[0079] FIG. 48 is a side view of an eighth embodiment, similar to
that of FIGS. 32-34, of a patient support structure, again, with
translation compensation on both outer ends thereof, according to
the invention, shown in a planar horizontal position, and including
reversibly attached stationary upper body support assembly and
hip-thigh pad structures.
[0080] FIG. 49 is a side view of the structure of FIG. 48 shown in
an inclined and upward breaking position, and including reversibly
attached upper body support and hip-thigh pad structures of FIG.
48.
[0081] FIG. 50 is a side view of the structure of FIG. 48 shown in
a Trendelenburg position, and including reversibly attached chest
support and hip-thigh pad structures of FIG. 48.
[0082] FIG. 51 is a side view of the structure of FIG. 48 shown in
a downwardly breaking position, and including reversibly attached
chest support and hip-thigh pad structures of FIG. 48.
[0083] FIG. 52 is a side view of the structure of FIG. 48 showing
the patient support structure and inward articulation in a
horizontal and tilted position, and with the reversibly attached
chest support assembly and hip-thigh pad structures of FIG. 48
removed.
[0084] FIG. 53 is a side view of the structure of FIG. 48 shown in
a horizontal and planar position, and including reversibly attached
torso support translator with an actuator and the hip-thigh pad
structures of FIG. 48 positioned on the foot end portion of the
frame adjacent the articulation, wherein D3 stays constant with
frame articulation.
[0085] FIG. 54 is an enlarged side elevational view of the
translation connector component of FIG. 5 to FIG. 33 and FIG. 48,
with portions broken away or shown in cross-section, so as to show
greater detail thereof.
DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
[0086] As required, detailed embodiments of the present invention
are disclosed herein; however, it is to be understood that the
disclosed embodiments are merely exemplary of the invention, which
may be embodied in various forms. Therefore, specific structural
and functional details disclosed herein are not to be interpreted
as limiting, but merely as a basis for the claims and as a
representative basis for teaching one skilled in the art to
variously employ the present invention in virtually any
appropriately detailed structure.
[0087] Referring now to the drawings, a patient positioning support
structure according to the invention is generally designated by the
reference numeral 1 and is depicted in FIGS. 1-12. The structure 1
includes first and second support piers or column assemblies 3 and
4 which are illustrated as independent, stationary floor base
support structures as shown in FIG. 1 or may be connected to one
another by a base support as illustrated in the embodiment shown in
FIG. 30. In some embodiments according to the invention as shown,
for example, in FIGS. 32-34, the base connection provides the
columns with a motorized length adjustment compensation at both
outer ends thereof. Additionally or alternatively, the base
connection may be non-motorized and selectively retractable, such
that the length of the base connection can be shortened, such as
but not limited to for storing the base with a smaller footprint
that the base has when in use. It is also foreseen that in certain
embodiments according to the invention, one of the support columns
may be replaced by a conventional operating room table as known in
the art, having transverse and longitudinal translation (see FIGS.
32-34 and 48-54), or may even be a wall mount.
[0088] In the first illustrated embodiment, each of the support
columns 3 and 4 includes a translation angulation connection
subassembly TAC (see FIGS. 5 and 6), which includes a pivotal
support assembly, a rotation subassembly and an angulation
subassembly, which are described in greater detail below. The
support column 3 includes an attached first pivotal support
connection assembly, generally 5, and the support column 4 includes
an attached second pivotal support assembly, generally 6. Between
them, the support connection assemblies 5 and 6 uphold an
optionally removable elongate, articulate jointed or breaking
patient holding or support structure, generally 10 and optionally,
a second removable patient support structure that will be described
with respect to another embodiment of the invention. The patient
support structure 10 includes a rigid outer frame with an inwardly
located articulation 16, such as but not limited to a real hinge or
a virtual articulation (not shown, and which may be referred to as
a virtual "hinge") and is connected to the base end supports by
connection assemblies 5 and 6, which are described in greater
detail below. The articulation is defined by being limited to
vertical translation as opposed to longitudinal translation, or a
combination of vertical and longitudinal translation. "Vertical
translation" means movement of a structure such that the height of
the structure is increased or decreased relative to the floor.
Longitudinal translation is generally movement that runs parallel
to the floor or to the longitudinal axis of the surgical table 1.
It is noted that in this embodiment, the connection assemblies 5
and 6 equally share the load inwardly and outwardly, as opposed to
load-bearing that is solely or primarily outwardly at the
connection assemblies 5 and 6.
[0089] The support connection assemblies 5 and 6 include structures
to provide for putting the outer ends of the support structure 10
into simultaneous roll, Trendelenburg, reverse Trendelenburg, pivot
or angulation and at least horizontal translation with respect to
each of the columns 3 and 4. The illustrated support structure 10
includes a first frame section 12, a second frame section 14 with
an optional transverse support cross bar 15, and a pivot or hinge
assembly, generally 16. In the illustrated embodiment, the pivot
assembly further an actuator in the form of includes a cable drive
system, including a dual winch 18 and cooperating cables 20;
however, other drive systems are foreseen.
[0090] The columns 3 and 4 are supported by outwardly extending
feet 22 that may or may not include spaced apart casters or wheels
(not shown) each equipped with a floor-lock foot lever for lowering
the feet 12 into a floor-engaging position as shown in FIG. 1. The
columns 3 and 4 each include two or more motorized lift arm
segments 3a, 3b and 4a, 4b, respectively that permit the height of
each of the columns 3 and 4 to be selectively increased and
decreased in order to raise and lower all or a selected portion of
the connected patient support structure 10 and position it into an
inclined orientation. It is foreseen that the vertical supports 3
and 4 may be constructed so that the column 3 has a greater mass
than the support column 4 or vice versa in order to accommodate an
uneven weight distribution of the human body. Such reduction in
size at the foot end of the system 1 may be employed in some
embodiments to facilitate the approach of personnel and equipment.
It is foreseen that other types of end column vertical height
adjustment mechanisms can also be used for the columns.
[0091] Each of the support piers or columns include a support
connection assembly 5 and 6. Each connection assembly 5 and 6
includes two or more subassemblies for moving the patient support
10 in a particular manner. Each connection assembly 5 and 6
includes a rotation subassembly 26 and 26' and an angulation
subassembly 27 and 27', respectively, that are interconnected as
will be described in greater detail below and include associated
power source and circuitry linked to a controller 29 (FIG. 1) for
cooperative and integrated actuation and operation so as to
maintain the hinges at a selected height and horizontal
relationship with respect to the floor. The rotational
subassemblies 26 and 26' enable coordinated rotation of the patient
support structure 10 about a longitudinal axis of the structure 1
and one generally located near an outer end of the patient support
structure. The angulation subassemblies 27 and 27' shown in FIGS. 2
and 3 include translation structure and enable the selective
hinging, articulation or breaking of the support 10 at the hinge
assembly 16 at desired levels and increments as well as selective
tilting of the frame portions 12,14 with respect to a longitudinal
axis of such frame portion with longitudinal translation
compensation occurring at both outer ends of the frame
portions.
[0092] The rotation subassembly or mechanism 26, shown in FIGS. 1
and 5, includes at least one motor housing 30 surmounting the
support column 3; however, the rotation mechanism could be located
closer to the patient support structure. In the illustrated
embodiment, only one rotational motor is provided, but it is
foreseen that a cooperating motor may also be mounted on the
support column 4. It is also foreseen that the rotational mechanism
could be located somewhere other than in support columns 3 and 4. A
main rotational shaft 32 is shown extending from the motor housing
30 that turns a rotation structure 33 in this particular
embodiment. The rotation structure 33 in turn rotates the connected
patient support 10 about a longitudinal axis as will be described
in greater detail below. The motor housing 30 contains a rotary
electric motor or other actuator drivingly engaged with the shaft
32. It is foreseen that the shaft could be located above or below
the outer end of the patient support structure. The rotation
mechanism 26 is operated by actuating the motor using a switch or
other similar means and can be controlled by a computer. The
rotation structure 33 is fixed to the shaft 32 at a location spaced
from the motor housing 30 and the support column 3 to provide
clearance for rotation of the connected patient support structure
10 in this embodiment.
[0093] As shown in FIGS. 4 and 5, the rotation structure 33 can be
attached to a pair of translation posts or H-bar posts 40 disposed
at either end of the rotation structure 33; however, other
connections are foreseen. The posts 40 are each attached to the
structure 33 by a pin 42, bolt, or other fixing structure. One or
more cooperating apertures 44 formed in the posts 40 can provide
passageway for a pivot pin 46 to extend therethrough. The pivot pin
46 is receivable in each cooperating pair of apertures 44 allowing
for selective placement of a pivoting translation connector
component 48 and 52 that, in this embodiment, is sized and shaped
to be received between the pair of posts 40 and also receive the
pivot pin 46 therethrough. This enables the translation connector
mechanism to have a transverse axis of rotation. The pin 46 and
connector 48, 52 are thus positionable in different angular
orientations with respect to the longitudinal extension of the
support 10, wherein this connection mechanism can also translate
horizontally at a variety of vertical heights to be selected by the
surgeon and readily changeable, even during surgery if necessary,
to vary the height of the frame section 12. In one specific
embodiment, the multiple location or height feature is also
advantageous when more than one frame or patent structure is
mounted in tandem as shown, for example in FIGS. 25-29. In this
embodiment, the position of the frame or other structure may be
desirably changed to provide close proximity to an imaging top with
a distance between a patient support and an imaging top being
expandable or reduceable depending upon the size or other
attributes of a patient and surgical or other requirements. As
illustrated in FIG. 5, in one embodiment, the connector component
or assembly 48, 52 has a slot 50 for receiving a pivot pin 46, to
provide for a passive transverse axis of rotation within the
translation compensation mechanism. Further, the slot 50 and pivot
pin 46 provide for manual, or passive, height adjustment, or
vertical translation, of the connector 48, by manually lifting the
connector 48 so that the slot 50 is aligned with the apertures 44
of the H-bar posts 40, and then passing or installing the pivot pin
46 through all three of the aligned apertures 44 and slot 50.
[0094] Also with reference to FIGS. 4 and 5, the translation
connector subassembly 48, 52 includes rigid attachment to an outer
end of the patient support structure. In this embodiment, the
attachment includes an additional pivot axis structure 52 with an
open ended slot 56, although other attachments to the patient
support structure are foreseen. The slot 56 is sized and shaped for
receiving an end connection 58 of the frame section 12. The
pivoting translation connector subassembly 48, 52 further includes
a through aperture or bore 60 running substantially perpendicular
to the slot. The aligned apertures 60, 60' are sized and shaped to
receive a pivot pin 62 therethrough oriented at a 90.degree. angle
with respect to the transverse pivot pin 46. The swivelable
connection for the translation connector subassembly provided by
the pin 62 provides for some passive forward and rearward lateral
movement and rotational movement of the attached frame end
connection 58 and thus the frame section 12, providing a degree of
freedom and clearance needed for rotating the patient support about
a longitudinal axis of a patient, with certain patient
manipulations. The inner portion of the multifunctional translation
connector subassembly is sized and shaped to frictionally engage
the frame end connection 58, thus securely fixing the end
connection 58 to the pivoting translation connector component of
the connection assembly. The frame end connection 58 is in turn
fixed to each of elongate frame members 66 and 68 of the frame
section 12. The frame members 66 and 68 are each hingedly connected
to the inward hinge assembly 16 to be described in greater detail
below. Pivoting of the translation connector subassembly 48, 52
with respect to the pin 46, or the transverse translation axis A2,
and the perpendicular axis A1 provides for selected articulation
(see FIGS. 5-6), or passive modifications in pitch, of the frame
section 12 (that includes the end connection 58 and the frame
members 66 and 68) and/or the entire support 10 with respect to the
support pier or column 3, wherein the entire patient support
structure is inwardly articulated and rolled with respect to the
longitudinal or roll axis R (see FIGS. 1 and 6). It if foreseen
that, depending upon the table, all of the subassemblies can be
powered (i.e., actively driven) or passive (i.e., movement with
respect to the axis is driven by movement occurring in another part
of the structure 1).
[0095] With reference to FIG. 6, at the support pier or column 4,
the support assembly 6 is substantially similar to the support
assembly 5; however, the rotation subassembly 26' can include a
motor or not include a motor. The support pier or column 4, again,
includes a powered mechanism to provide selective height adjustment
of the subassembly 26'. A rotation structure 33' is inwardly spaced
from the column 4. The structure 33' includes a shaft (not shown)
extending outwardly therefrom similar to the rotation shaft 32, the
shaft being, again, rotatingly related to both the patient support
structure and the support column 4.
[0096] In this particular arrangement shown, the rotation
subassembly 26' and the angulation subassembly 27' otherwise
include elements identical to or substantially similar to the
elements of the subassemblies 26 and 27. Specifically, H-bar posts
40', pin 42', apertures 44', pivot pin 46', translation connector
subassembly 48', 52', end connector 58' and pivot pin 62', are
identical or substantially similar in form and cooperate with other
elements identically or substantially similarly to what has been
described previously herein with respective H-bar posts 40, pin 42,
apertures 44, pivot pin 46, translation connector subassembly 48,
52, end connector 58 and pivot pin 62.
[0097] The frame 14 further includes frame members 66' and 68' that
are each fixed to the end connector 58'. The frame members 66' and
68' are pivotally or hingedly connected to respective frame members
66 and 68 by the hinge assembly 16. Specifically, the frame member
66 is attached to the frame member 66' by the hinge mechanism 70
and the frame member 68 is attached to the frame member 68' by the
hinge mechanism 72, which, again, are preferably radiolucent.
[0098] With particular reference to FIGS. 3, 7 and 9-11, the hinge
mechanism 70 includes an outer member 76 and an inner member 78.
The outer member 76 is fixed or may be integral with the elongate
frame member 66, while the inner member 78 is integral or otherwise
fixed to the frame member 66'. The outer member 76 further includes
an extension 80 with a groove 82 for receiving and guiding the
cable 20. The extension 80 tapers in a direction from the outer
member interior 84 to the groove 82. The extension 80 is configured
to cause a slight upward break or bend of the support 10 when the
extension 80 comes into contact with the cable 20 at the groove 82.
In that way, when the cables 20 are reeled in to shorten the
hypotenuse of the triangle formed by the cable, the section 12 and
the section 14, the sections 12 and 14 move toward one another,
resulting in the upward break as illustrated, for example, in FIG.
18. The downward break or joint illustrated, for example, in FIG.
21 is a result of lengthening the cable 20 distance and allowing
gravity to drop the hinge 70. The extension 80 is shaped to extend
slightly inwardly toward a longitudinal axis A of the support 10,
thereby guiding the cable 20 along a path within a periphery of the
frame sections 12 and 14 when the extension 80 is in contact with
the cable 20 when in a downward breaking configuration directed
toward the cable with the cable 20 being received at the groove
82.
[0099] It is foreseen that if an exclusively upward breaking or
jointing embodiment is desired according to the invention, the
sections 12 and 14 may be positioned with respect to two end
columns to always include a slight upward break, joint or bend at
the hinge or pivot between the sections 12 and 14. When the base is
actuated to move the columns toward one another, the sections 12
and 14 would automatically further break or articulate upwardly and
toward one another. Downward breaking or jointing would not be
possible in such an embodiment as the maximum distance between the
two end columns would still ensure a slight upward break or hinge
between the sections 12 and 14. Such an embodiment would be
acceptable for use because patient holding pads could be positioned
on the frames 12 and 14 such that the patient would be in a
substantially horizontal position even when there is a slight
upward bend or break at the hinge between the sections 12 and
14.
[0100] Returning to the hinge 70 of illustrated embodiment, the
inner member 78 is slidingly and rotatably receivable in an
interior 84 of the outer member 76. The outer member has a pair of
pivot apertures 86 and the inner member has a pivot aperture 87,
the apertures cooperating to create a through bore for receiving a
pivot pin 88, preferably radiolucent, through both the inner and
outer hinge members. The interior 84 includes a curved partially
cylindrical surface 89 for slidingly receiving a cooperating outer
rounded and partially cylindrical surface 90 of the inner member
78. The inner member 78 further includes a downward breaking stop
or projection 92 that limits a downward pivot (in a direction
toward the cables 20) of the hinge 70 in the event the cables 20
should fail. The stop 92 abuts against a surface 93 of the interior
84. In the illustrated embodiment, the stop 92 limits the extent of
rotation or hinging of the section 66 with respect to the section
66' to about twenty-five degrees. Upward pivot (in a direction away
from the cables 20) is limited by abutment of an inner planar
surface 95 with a planar surface 96 of the hinge inner member
78.
[0101] With particular reference to FIG. 8, the hinge mechanism 72
is substantially a mirror image of the hinge mechanism 70 and
therefore includes the following elements: a hinge outer member
76', an inner member 78', an extension 80' with a groove 82', an
interior 84', pivot apertures 86', a pivot pin 88', a curved
surface 89'(not shown), an outer surface 90' (not shown), a stop
92' (not shown), an abutment surface 93', an inner planar surface
95' and a planar surface 96' that are identical or substantially
similar in shape and function to the respective hinge outer member
76, inner member 78, extension 80, groove 82, interior 84, pivot
apertures 86, pivot pin 88, curved surface 89, outer surface 90,
stop 92, abutment surface 93, inner planar surface 95 and planar
surface 96 described herein with respect to the hinge 70.
[0102] It is noted that other hinge or pivot mechanisms may be
utilized in lieu of the hinge assembly 16. For example, the
polyaxial joint 95 illustrated and described in Applicant's U.S.
Pat. No. 7,152,261 and pending U.S. patent application Ser. No.
11/159,494 filed Jun. 23, 2005, may be incorporated into the
patient support structure 10 at the break or joint between the
sections 12 and 14. The disclosures of U.S. Pat. No. 7,152,261 and
U.S. patent application Ser. No. 11/159,494 are incorporated by
reference herein. It is foreseen that a rotating universal joint
operated type of hinge mechanism could be used with the invention,
and the like. While a lead screw drive could also be utilized, a
more radiolucent joint or hinge is preferred.
[0103] With particular reference to FIGS. 6 and 12, the cable drive
system 18 includes a rotary motor 98 cooperating with and driving
by rotation a pair of winch cylinders 99 disposed on either side of
the motor 98. The motor 98 and cylinders 99 are mounted to the end
connector 58' located near the support column 4. Each cable 20 is
attached to one of the winch cylinders 99 at one end thereof and to
the end connector 58 at the other end thereof. In a first
longitudinal position wherein the section 12 is substantially
planar with the section 14, the cables 20 are wound about the winch
cylinders 99 an amount to provide enough tension in the cables 20
to maintain such a substantially planar orientation and
configuration, with the hinge extensions 82 and 82' being in
contact with each of the cables 20. The motor 98 is preferably low
speed and high torque for safely winding both of the cables 20
simultaneously about the cylinders 99 to draw the section 12 toward
the section 14 to result in an upward breaking or jointing
configuration with the hinges 70 and 72 disposed in spaced relation
with the cables 20 and the hinges 70 and 72. The motor 98 may be
reversed, reversing the direction of rotation of the winch
cylinders 99 for slowly unwinding the cables 20 to a downward
breaking or jointing configuration. As the cables 20 unwind,
gravity draws the support sections 12 and 14 downward with the
cables 20 being received in the grooves 82 and 82' of the hinge
extensions 80 and 80'. As the cables 20 slacken, the hinges 70 and
72 continue to lower pressing down upon the cables 20. Again,
different ways to move the hinges are foreseen both directly and
indirection with actuators that are more or less load-bearing.
[0104] It is noted that the frame sections 12 and 14 are typically
equipped with pads (not shown) or other patient holding structure,
as illustrated, for example, in Applicant's U.S. Pat. No.
5,131,106, the disclosure of which is incorporated by reference
herein. It is foreseen that such patient holding structure could
translate or glide along the frame sections 12 and 14 and be
radiolucent. Furthermore, with respect to FIGS. 13 and 14, the
frame member sections 66 and 68 of section 12 and the frame member
sections 66' and 68' of the section 14 may be replaced with
substantially rectangular radiolucent imaging tops or sections 100
and 101' respectively. Each of the sections 100 and 101' having
elongate slots 101 formed therein to allow for attachment of the
hinge mechanisms 70 and 72 in a manner identical or substantially
similar to what has been described herein with respect to the frame
sections 12 and 14.
[0105] With reference to FIGS. 15-17, the imaging sections 100 and
100' are illustrated, replacing the frame sections 12 and 14 of the
embodiment disclosed in FIGS. 1-12. Each of FIGS. 15-17 represent
configurations in which the cable drive 18 is tensioned such that
the sections 100 and 100' are kept in a substantially coplanar
configuration. FIG. 15 illustrates a configuration in which the
column 3 is elevated upwardly with the frame sections hinging at
the support assemblies 5 and 6, resulting in an inclined position
or configuration of the entire patient support. In the illustrated
embodiment, the section 100 would preferably receive a patient's
head. Therefore, FIG. 15 illustrates a reverse Trendelenburg
position or orientation. FIG. 16 illustrates the sections 100 and
100' again in a substantially common plane with both sections being
rotated to a tilted position produced by a powered rotation of the
sub assemblies 26 and passive rotation of the assembly 26' with
both columns 3 and 4 otherwise holding the sections 100 and 100' at
the same height. FIG. 17 illustrates both tilting due to rotation
of the assemblies 26 and 26' and also a sloping or inclined
position with the column 4 being extended vertically. Thus, FIG. 17
illustrates a Trendelenburg position or orientation with both the
sections 100 and 100' remaining in substantially the same plane. It
is foreseen that a bearing block assembly at one or both ends of
the table could provide for some lateral or transverse translation
along with horizontal translation to prevent binding of the hinge
mechanisms.
[0106] With reference to FIGS. 18-20, there is illustrated three
upward breaking or hinging configurations of the structure 1. FIG.
18 illustrates a symmetrical upward breaking configuration wherein
the columns 3 and 4 and their respective support connection
assemblies 5 and 6 are holding the patient support structure at
substantially the same height with the cables 20 being shortened by
rotation of the winch motor to result in an upward break or joint
in the hinge assembly 16. FIG. 19 illustrates the column 3 being
extended to a maximum height and the cables reeled to shorten a
distance between the sections 100 and 100'. An example of such an
upward break or joint with reverse Trendelenburg would be a head or
column 3 height of 43 inches, a foot or column 4 height of 24
inches and a 35 degree upward break with zero degree roll. FIG. 20
illustrates an upward breaking Trendelenburg with the column 4
being extended to a maximum height.
[0107] With reference to FIGS. 21-23, there is illustrated three
downward breaking configurations of the structure 1. FIG. 21
illustrates a symmetrical downward breaking configuration wherein
the columns 3 and 4 are holding the outer ends of the patient
support structure, at the same height with the cables 20 being
unwound or slackened to result in a downward break or joint in the
hinge assembly 16, the hinges 70 and 72 contacting the cables 20.
FIG. 22 illustrates a downward breaking reverse Trendelenburg with
the column 3 being extended to a maximum height resulting in a
patent's head end being at a maximum height. FIG. 23 illustrates a
downward breaking Trendelenburg with the column 4 being extended to
a maximum height.
[0108] It is noted that in each of the configurations illustrated
in FIGS. 18-23, the sub-assemblies 26 may be rotated in either
direction, resulting in a tilted or rotated as well as upwardly or
downwardly broken or hinged configuration. For example, FIG. 24
illustrates the structure 1 with support frame sections 12 and 14
positioned in a configuration similar to that illustrated in FIG.
19, but also including rotation, resulting in a tilting and
upwardly breaking or jointed configuration of the structure 1. An
example of the position illustrated in FIG. 24 would be: a head or
column 3 height of 41 inches, a foot or column 4 height of 34
inches and a 35 degree upward break or joint with 10 degree roll.
Such positioning capabilities is associated with translation
compensation occurring at both outer ends of the breaking patient
support structure.
[0109] With reference to FIGS. 25-29, another structure, generally
102 according to the invention is illustrated. The structure 102
utilizes all of the elements described herein with respect to the
structure 1 and therefore the same references numerals are used for
the same elements or features. The structure 102 differs from the
structure 1 in that the H-bar posts 40 and 40' are replaced or
modified to be extended H-bar posts 40A and 40A', allowing for the
mounting of two elongate structure 10 and cooperating cable drives
18 or other actuators to move the hinges. In the embodiment shown
in FIG. 25, one of the structures 10 includes the frame member 12
and 14 while the other structure is an imaging top having sections
100 and 100'. As previously described herein, the cooperating H-bar
posts 40A and 40A' equipped with a plurality of apertures allows
for the placement of the support structures 10 at a variety of
locations. For example, FIGS. 25-28 illustrate a first spaced
orientation of the elongate frame with respect to the elongate
imaging top with the imaging top located at a "lower" position
identified by the reference letter L. The identical components are
shown in FIG. 29 with the imaging top located at a "mid-position"
identified by the reference letter M, illustrating a more compact
or closely spaced orientation of the elongate frame with respect to
the elongate imaging top than what is shown in FIG. 25.
[0110] As illustrated in FIGS. 25-28, the structure 102 provides
for the complete rotation and thus a roll-over of a patient by
actuation of the motor of the rotation subassembly 26 using the
controller 29. The structure 102 shown in FIGS. 25-29 is further
illustrated with a base support 110 fixed to each of the columns 3
and 4 and rollers or castors 112 at the base of the structure
102.
[0111] With reference to FIGS. 30 and 31, further embodiments
according to the invention, generally 200 is illustrated. The
system 200 broadly includes an elongate length-adjustable base 202
surmounted at either end by respective first and second upright
support piers or columns 203 and 204 which are connected to
respective first and second support connection assemblies,
generally 205 and 206 that translate, rotate, and angulate or
pivot. Between them, the support assemblies 205 and 206 uphold an
elongated breaking, hingeable or pivotable patient support
structure, generally 210. The hinge structure is described in
detail in Applicants's U.S. Pat. No. 7,152,261 and also U.S. patent
application Ser. No. 11/159,494, both disclosures of which are
incorporated by reference herein. In this embodiment, the inward
articulations remain mostly unloaded and translation compensation
can occur at both outer ends of the patient support structure. The
embodiment 200A illustrated in FIG. 31 differs from the structure
200 only in that the length-adjustable base 202 is replaced by a
first base 220 attached to the pier 203 and a second base 222
attached to the pier 204. All of the bases 202, 220 and 222 include
castors or rollers 230 or some other movable structure to allow the
piers 203 and 204 to move toward and away from one another during
upward or downward breaking of the structure 210. In this
embodiment, it is foreseen that actuators would provide rotation,
angulation and horizontal translation at both outer ends of the
patient support structure.
[0112] It is foreseen that cable drives, as described herein, other
types of motor drives, including screw drives with gears, universal
joints, hydraulic systems, and other like actuators, may be
utilized to facilitate both upward and downward breaking of the
support structure 210.
[0113] Another patient support structure according to the
invention, generally 301, is illustrated in FIGS. 32-34, again,
providing translation compensation on both outer ends. The
structure 301 generally includes a translating actuator on one end
known in the prior table art as an inclinable and transversely and
horizontally translatable operating table support structure 304, a
vertically height adjustable end support or pier 306 and a hinged
or pivotally upwardly and downwardly breaking or jointing support
structure 310 connected to both the structure 304 and the pier 306
by pivoting translation compensation mechanisms. The patient
support structure 310 further includes a first actively angulated
section 312 moved by an actuator and a second section 314. The
first section 312 is fixed to and extends from the operating table
support 304. The second section is attached to the pier 306 by a
pivoting translation connector assembly 320, such as the support
connection assembly 5 described herein with respect to the
structure 1. The hinge mechanism 316 disposed between the support
sections 312 and 314 may be a conventional hinge, pivot, or pivot
or hinge systems previously described herein. Preferably, it is a
simple hinge and does not need to carry much load.
[0114] In use, the operating table support 304 utilizes electric or
other power means to move the support section 312 up and down at an
incline and to translate it transversely and longitudinally, as is
known in the art. The operating table support 304 can also tilt or
rotate from side to side. In response to the movement of the
section 312, the section 314 also moves, resulting in upward and
downward breaking illustrated in FIGS. 33 and 34. In response to
the movement of the section 312, the connection 320 provides
translation compensation horizontally along with rotation and
angulation degrees of freedom of movement. The pier 306 includes a
motor for raising and lowering the pier at the connection 320. It
is foreseen that the connection 320 could have actuators for
rotation, angulation and translation.
[0115] As stated above with respect to other embodiments of the
invention described herein, it is foreseen that cable drives as
described herein, other types of drives including screw drives,
gear mechanisms, hydraulic systems, and other actuator like
mechanisms, may be utilized to facilitate both upward and downward
breaking of the support structure 310 at the joint 316.
[0116] With reference to FIGS. 35-47, another patient support
structure according to the invention, generally 401 includes first
and second upright support piers or columns 403 and 404 that are
connected to one another by a base support 402. In some embodiments
according to the invention, each column may be surmounted on an
independent movable or stationary base. The column 403 is connected
to a first support assembly, generally 405 and the column 404 is
connected to a second support assembly, generally 406. Between
them, the support assemblies 405 and 406 uphold at least one
removable elongate and articulate, substantially centrally jointed
or breaking patent holding or support structure, generally 410. The
assembly includes a first frame section 412, a second frame section
414 and a pair of identical hinge assemblies, generally 416,
disposed between and connecting the first and second frame sections
412 and 414. In the illustrated embodiment, the first frame section
412 for holding a head and upper body of a patient is of a slightly
shorter longitudinal length (along an axis X) than the second frame
section 414. Therefore, the spaced hinge assemblies 416 are
approximately centrally located relative to a body of a patient
being placed on the structure 410. In the illustrated embodiment,
the hinge assembly further includes a drive system that includes a
pull rod assembly, generally 418, and cooperating spaced slider
bars 420. Again, other drive systems are foreseen, especially lead
screws, chains and other linkages.
[0117] The columns 403 and 404 are substantially similar in form
and function to the columns 3 and 4 previously described herein
with respect to the structure 1. The columns 403 and 404 are
supported by outwardly extending feet 422 that include casters that
may be equipped with a floor-lock foot lever for lowering the feet
422 into a floor-engaging position. The columns 403 and 404 each
include two or more lift arm segments respectively that permit the
height of each of the columns 403 and 404 to be selectively
increased and decreased in order to raise and lower all or a
selected portion of the connected patient support structure
410.
[0118] Each of the support connection assemblies 405 and 406
generally includes a rotation subassembly 426 and 426' and an
angulation subassembly 427 and 427', respectively, that are the
same or substantially similar to the subassemblies 26, 26', 27 and
27' previously described herein with respect to the structure 1. In
the illustrated embodiment, the angulation subassembly 427
connected to the frame 412 for holding the head and upper body of a
patient is shown as substantially identical to the subassembly 27
and, therefore, shall not be described further herein. The
subassembly 427' is substantially similar to the subassembly 27',
but with some modifications, including a frame 436 disposed
transverse to the overall longitudinal axis X of the structure 401,
the frame 436 providing for slidable support of the pair of
identical slider bars 420 that are disposed at either side of the
frame 414 and near the subassembly 427'.
[0119] Similar to the rotation subassembly 26 previously described
herein, the rotation subassembly or mechanism 426, includes at
least one motor housing 430 surmounting the support column 403. It
is foreseen that a cooperating motor may also be mounted on the
support column 404. A main rotational shaft 432 extends from the
motor housing 430 that turns a rotation structure or bar that in
turn is connected to and rotates the patient support 410 about a
longitudinal axis. In particular, the motor housing 430 contains a
rotary electric motor or other actuator drivingly engaged with the
shaft 432. The rotation mechanism 426 is operated by actuating the
motor using a switch or other similar means. The shaft 432
rotationally cooperates with a pair of substantially vertically
disposed translation posts or H-bar posts 440, the posts 440 being
attached to and disposed at either end of the transverse rotation
structure or bar 433. Each H-bar post 440 includes a plurality of
apertures 444, allowing for selective, hinged vertical placement of
the frame section 412 identical or substantially similar to what
has been described previously herein with respect to the H-bar
posts 40, the angulation sub-assembly 27 and the frame end section
58 of the frame section 12 previously described herein with respect
to the structure 1.
[0120] With particular reference to FIGS. 38-40, as stated above,
the sub-assembly 426' is substantially similar to the sub-assembly
426 and therefore may include a motor and further includes either
an active or passive rotational shaft 432' that engages a rotation
structure or bar 433' that is attached to a pair of substantially
vertically disposed H-bar posts 440'. A plurality of cooperating
apertures 444' formed in the posts 440' provide passageway for a
pivot pin 446 to extend therethrough. The pivot pin 446 is
receivable in each cooperating pair of apertures 444', allowing for
selective placement of a translation connector 448, 452 component
that is part of the connection assembly. In this embodiment, the
translation connector is sized and shaped to be received between
the pair of posts 440' and also receive the pivot pin 446
therethrough. The pin 446 and connector 448 are thus positionable
in an orientation transverse to the longitudinal axis X of the
patient support frame 410 at a variety of heights to be selected by
the surgeon and readily changeable, even during surgery if
necessary, to vary the height of the frame section 414. The
multiple location or height feature is also advantageous when more
than one frame or patent structure is mounted in tandem, for
example, when both a frame and imaging table are used together,
such as is shown in the embodiment illustrated in FIGS. 25-29. The
position of the frame or other structure may be desirably changed
to provide close proximity to an imaging top with a distance
between a patient support and an imaging top being expandable or
reduceable depending upon the size or other attributes of a patient
and surgical or other requirements. The connector 448 has a slot
for translatably receiving the pivot pin 446. It is noted that the
H-bar support 440', apertures 444', elongate transverse pin 446 and
translation connector 448, 452 component are the same or
substantially similar in form and function with the respective
support 40, apertures 44, transverse pin 46 and translation
connector 48 previously described herein with respect to the
structure 1.
[0121] The translation connector 448, again, has an attached pivot
connector 452 that is substantially similar to the pivot connector
52 previously described herein, with the exception that rather than
being attached directly to an end piece or section of the patient
support frame 414, the pivot connector 452 is fixed to the frame
436 that is fixed to and supports the slider bars 420 near end
surfaces 464 thereof. Thus, the slider bars 420 are in a hinged
relationship with the H-bar supports 440'. The slider bars 420 are
also in slidable relation with the frame section 414 while being
securely attached thereto and disposed substantially parallel to a
longitudinal axis of the section 414, as will be described in
greater detail below. Such slidable attachment facilitates upward
and downward breaking or hinging of the section 414 with respect to
the section 412 at the hinge mechanism 416. Also as more fully
described below, the pull rod assembly 418, that is connected to
both the frame section 414 and the hinge mechanism 416, is
rotatable so as to control the hinge or break angle of the patient
support 410 and render the support 410 rigid at a desired upward or
downward break or joint of the hinge mechanism 416.
[0122] With particular reference to FIGS. 38 and 39, the support
frame section 414 includes opposed elongate and parallel frame
sections 466 and 468 attached to one another by a transverse end
frame section 469. A support plate 470 is attached to and is
disposed below each of the sections 466, 468 and 469 to provide
additional support and stability to the frame section 414 at and
near the end section 469. Further support is provided by a pair of
frame support plates 471, both of which are fixed to the end
support frame section 469 near one end thereof; one plate 471 being
fixed to the section 466 and the other plate 471 being fixed to the
section 468. At least one pair of slider bar holding structures 472
are fixed to the support plate 470 and extend downwardly therefrom
at each of the frame sections 466 and 468. Each structure 472
includes a through bore that extends parallel to the frame sections
466 and 468, the structure 472 for slidably receiving one of the
slider bars 420 directly below one of the frame sections 466 and
468 and also orienting the pair of slider bars 420 in a direction
substantially parallel to the frame sections 466 and 468. The
illustrated slider bar holding structures 472 are spaced from the
end frame section 469 and located near a forward edge 473 of the
plate 470. In the illustrated embodiment, the holding structures
472 are also bolted to the frame sections 466 or 468. A pair of
pull-rod supports 475 are also fixed to the support plate 470 and
the frame 414 and extend downwardly therefrom at each of the frame
sections 466 and 468 and also downwardly from the end frame section
469. Each structure 475 includes a through bore for receiving a
transverse pivot pin or bar 476 mounted below the slider bars 420.
The pull-rod assembly 418 is attached to the support 475 at the
pivot pin 476 and is thus in hinged relationship with the support
475, pivotally attached thereto at end portions 478.
[0123] The actuator assembly 418 further includes a pair of
housings 480, each housing attached to an end portion 478 and
having a powered actuator 482 cooperating with one of a pair of
rotatable extendible and retractable rods 484 and a pair of hinge
connectors 486, each pivotally attached to a respective cam plate
488 of the respective hinge mechanism 416 at a respective pivot pin
490. The cam plate 488 has a substantially centrally located
curvilinear wall 489 forming a curvate aperture or slot, a lower
circular aperture for receiving the pin 490 and an upper circular
aperture for receiving a pin 502, described in greater detail
below. Each pull rod 484 is rotatably mounted within one of the
housings 480, such rotation being controlled by operation of the
actuator 482 located in the housing 480 and engaged with the rod
484 to screw and thus selectively move or draw the rod 484 into or
away from the hinge mechanism 416 in a direction along a
longitudinal axis of the rod 484, that in turn results in breaking
or jointing of the patient support 410 at the hinge mechanism 416.
It is foreseen that other embodiments according to the invention
may utilize other types of push/pull rods or actuator mechanisms,
including, for example hydraulic systems and actuators that can
provide angulation. An additional centrally located pull-rod or
piston may be included to provide additional support. Furthermore,
other hinge mechanisms according to the invention may be utilized
in lieu of the mechanism 416, for example including, but not
limited to, polyaxial joints, roller with spokes, sprockets,
toothed gears, universal axis gears, or the like.
[0124] With particular reference to FIG. 41, the illustrated pair
of hinge mechanisms 416, each having a cam plate 488, further
include a pair of forked arms 492 extending from the frame section
412 and a pair of cooperating forked arms 494 attached to and
extending from the section 414. Hinge arms 496, 497, 498 and 499
having apertures near opposite ends thereof for receiving pivot
pins cooperate with the respective cam plate 488 and adjacent
forked arms 492 and 494 at pivot pins 501, 502, 503 and 504. All of
the pivot pins 490, 501, 502, 503 and 504 are disposed transverse
to the longitudinal axis X of the patient support structure 401. In
particular, the pivot pin 501 is received by circular apertures
located near first ends of the hinge arms 496 and 498 and a
circular aperture in the arm 492, thus pivotally attaching the arm
492 with both the hinge arms 496 and 498. The pivot pin 502 is
received by an upper circular aperture in the cam plate 488 and
circular apertures located near the ends of each of the forked arms
492 and 494, thus pivotally attaching the cam plate 488 with both
of the forked arms 492 and 494. The pivot pin 503 is received by
circular apertures located near first ends of the hinge arms 497
and 499 and a circular aperture in the arm 494, thus pivotally
attaching the arm 494 with both the hinge arms 497 and 499. The
pivot pin 504 is received by the slot 489 and also by circular
apertures located near second ends of the hinge arms 496, 497, 498
and 499, thus pivotally attaching all four hinge arms 496, 497, 498
and 499 with the cam plate 488 at the slot 489.
[0125] Also, with particular reference to FIGS. 35 and 38-41, the
structure 401 is shown in a neutral, planar orientation, with the
pull-rod assembly 418 holding the hinge mechanism 416 in such
neutral position, with the forked arms 492 and 494 in parallel. In
such position, the pin 504 is located at or near a rear-ward end of
the slot 489.
[0126] With reference to FIGS. 42-44, as the rod 484 is rotated to
selectively move the hinge mechanism, the pin 504 remains near the
rear-ward end of the slot 489 and the action of the rod causes the
hinge mechanism 416 to pivot the cam plate 488 at the pivot pin
490, causing the arms 492 and 494 to move toward the rod hinge
connector 486 and thus pivot the patient support at the pin 502,
causing a downward break or joint in the patient support 410. With
reference to FIGS. 45-47, as the rod 484 is rotated to selectively
shorten the length thereof, the support portion 414 slides along
the slider bars 420 away from the end support 404. At the same
time, the pin 504 slides along the slot 489 to an opposite or
forward end thereof as the cam plate pivots in a forward direction
about the pin 490. The movement of the rod 484 thus causes an
upward break at the pivot pin 502. In the illustrated embodiment,
the patient frame is pinned at the head end, but is free to move
along the fixed slider bar 420 at the foot end, providing dynamic
support to the patient frame. The slider bar mechanism can be
attached to a bearing block mechanism to provide lateral or
transverse translation movement, as described previously. The
sidebar is configured to provide for a considerable amount of
translation which is required for this type of breaking table.
[0127] It is noted that since the patient frame is free to move
over the slider bar, a horizontal force component is generated by
the combined components of the patient support. When the support is
broken or jointed upward, the angle of the foot end frame imparts a
horizontal force on the slider that urges the end supports 403 and
404 toward one another. When the table is broken downward, a
horizontal force develops that tends to push the end supports
apart. It has been found that the magnitude of the horizontal force
is a function of support loading and break angle, and thus, for
example, if a working limit of five hundred pounds is selected for
the patient support, a worst case of horizontal loading is only
about fifty-eight pounds at an upward break or joint of thirty-five
degrees. It is noted that the illustrated structure 401
advantageously supports a breaking or jointing range from about
thirty-five degrees up to about twenty degrees down. Throughout
such range, the horizontal forces imposed by the structure are
minimized by the illustrated locked support frame that moves on a
slider bar at the foot end of the support. This provides a
significant improvement to the prior art.
[0128] As with the structure 1 configurations illustrated in FIGS.
18-23, the upward and downward breaking of the patient support 410
may be modified by placing the portions 412 and 414 at different
vertical locations along the H-bar supports 440 and 440', thus
resulting in symmetrical or asymmetrical breaking configurations.
Furthermore, the portions 412 and 414 may be rotated or tilted as
described above with respect to the structure 1.
[0129] With reference to FIGS. 48-54, another patient support
structure according to the invention, generally 601, includes a
floor mounted base 602, a conventional or standard vertically
adjustable, and inclinable operating table support structure 604
known in the industry, a vertically height adjustable end support,
pier or column 606 and a hinged or pivotally upwardly and
downwardly breaking or jointing patient support structure 610
connected to both the table support structure 604 and the pier 606
with pivoting translation compensation capabilities. The patient
support structure 610 further includes a first frame section 612
and a second frame section 614 joined together by a pair of
upwardly and downwardly breaking hinges 616. An intervening second
base, longitudinal translation subassembly or longitudinal
translation connector 617 surmounts the operating table support
604. The first frame section 612 is engaged by, fixed or attached
to the second base 617 such that the first frame section 612
extends outwardly from the operating table support 604 and toward
the pier 606. The table support structure 604 includes a powered
mechanism, electronics and a controller 618 for selectively
adjusting the height, inclination and tilt or roll of the patient
support structure 610. The second base 617 includes a motor (not
shown), electronics (not shown) and structure that slidingly moves
or longitudinally translates the first frame section 612 with
respect to the operating table support 604.
[0130] The second base 617 slidingly moves, or translates in a
longitudinal direction, the first frame 612 a distance D1 toward or
away from the pier 606, as is indicated by the arrow 623. The
distance D1 is measurable from the rear or outer end 617a of the
second base 617 and the rear or outer end 612a of the first frame
section 612. Longitudinal translation, or longitudinal movement or
sliding, of the first frame section 612, such as with respect to
the operating table support 604, and resultant changes or variation
in D1, is coordinated and synchronized by a controller with changes
in the angulation of the hinges 616, at the table support 604 and
at the pier 606, so as to position the patient support 610 in
various positions determined by the surgeon, such as is described
elsewhere herein. In this embodiment, the hinges 616 themselves
need not carry much load.
[0131] The pier or support column 606 includes a rotation
subassembly, generally 626, and an angulation subassembly,
generally 627, that are interconnected and include an associated
power source and circuitry linked to a controller, such as but not
limited to controller 618, for cooperative and integrated actuation
and operation. The rotation subassembly 626, an angulation
subassembly 627 and pivoting translation subassembly are the same
or substantially similar to the rotation subassembly 26', the
angulation subassembly 27', and the translation connector 48, 52 in
FIGS. 4 and 5, respectively. The rotational subassembly 626 enables
coordinated rotation or tilting of the patient support structure
610 about the longitudinal axis of the structure 601. The
angulation subassembly 627 enables the selective hinging,
articulation or breaking of the patient support 610 at the hinge
assemblies 616 at desired levels and increments as well as
selective tilting of the frame portions 612, 614 with respect to a
longitudinal axis of such frame portion.
[0132] The rotation subassembly or mechanism 626, shown in FIGS.
48-54, includes at least one motor housing 630 surmounting the pier
606. A main rotational shaft 632 (most easily seen in FIG. 54)
extends from the motor housing 630 that turns a rotation structure
633. The rotation structure 633 in turn rotates the connected
patient support 610 about a longitudinal axis. The motor housing
630 contains a rotary electric motor or other actuator drivingly or
actively engaged with the shaft 632. The rotation mechanism 626 is
operated by actuating the motor using a switch or other similar
means, such as but not limited to controller 618, such as is known
in the art. The rotation structure 633 is fixed to the shaft 632 at
a location spaced from the motor housing 630 and the pier 606 to
provide clearance for rotation of the connected patient support
structure 610. In some embodiments, the rotation subassembly 626
can be passive and, therefore, not include a motor. However, the
support pier 606 preferably includes a powered mechanism to provide
selective height adjustment of the assembly 626. The rotation
subassembly can be at different locations between the end support
of the base and the outer end of the patient support structure.
[0133] In the embodiment shown, the rotation structure 633 is
attached to an H-frame bracket 640. The translation connector
subassembly is the bracket located by a pin 642, bolt, or other
fixing structure. The pivot pin 646 and translation connector 648
are thus positionable in an orientation transverse to the
longitudinal extension of the patient support 610. As illustrated
in FIG. 54, the translation connector 648 includes a slot 650 for
receiving the pivot pin 646 therethrough. The translation connector
648 is slidable with respect to the pivot pin 646, as is described
in greater detail below.
[0134] The translation connector subassembly 648 again includes a
pivot connector 652. The pivot connector 652 is the same or
substantially similar to the pivot connector described above with
respect to FIGS. 4 and 5. The pivot connector 652 includes a slot
sized and shaped for receiving an end connection 658 of the frame
section 614. The pivot connector 652 further includes a through
aperture or bore 60 running substantially perpendicular to the slot
654 and communicating therewith. As shown in FIG. 54, the aperture
660 is sized and shaped to receive a pivot pin 662 therethrough.
The connector 648 also includes a through bore 660' that receives
the pivot pin 662. The swivelable connection provided by the pin
662 allows for some forward and rearward lateral movement of the
attached frame end connection 658 and thus the frame section 614,
providing a degree of freedom and clearance needed for rotation or
tilting the patient support 610 about a longitudinal axis of a
patient. The slot 656 is sized and shaped to frictionally engage
the frame end connection 658, thus securely fixing the end
connection 658 to the pivot connector 652. The frame end connection
658 is in turn fixed to elongate frame members 667 and 668 (see
FIG. 52) of the frame section 614. The frame members 667 and 668
are each hingedly connected to the hinge assembly 616 as described
herein. Pivoting of the translation connector 648 with respect to
the pin 646 provides for selected articulation, angulation or
pivoting of the frame section 614 (that includes the end connection
658 and the frame members 667 and 668) and/or the entire support
610 with respect to the support pier or column 606.
[0135] With reference to FIG. 54, a bold dashed line that is
parallel with the axis A1, intersects the transverse pivot pin 646.
The pivot pin 646 is spaced a variable distance D1 from the A1
axis, wherein the distance D1 is measured between the A1 axis and
the bold dashed line. As the patient support 610 is moved between
various positions, the translation connector subassembly 648 is
moved or translated along the pivot pin 646 at slot 650 and toward
or away from the pier 606, as is indicated by the arrows D2.
Accordingly, the distance D2 varies in cooperation with actuation
of other components of the apparatus 601 that position the patient
support 610. The translation connector subassembly 648 moves with
respect to the pivot pin 646 in response to movement increasing and
decreasing the inclination of the patient support 610 and
positioning the patient support 610. When the frame 610 is inclined
or placed in a breaking position or configuration (see FIGS. 49-51)
the translation connector subassembly 648 moves away from the pier
606, thereby increasing the distance D1 between the axis A1 and the
transverse axis. Upon returning to the planar position that is
parallel with the floor (see FIGS. 48-52-53) the translation
connector subassembly 648 moves toward the pier 606, thereby
decreasing the distance D2. For example, when the patient support
610 is in a planar position parallel with the floor (FIGS. 48, 52
and 52), the translation connector 648 is in a starting position
with respect to the pivot pin 646, and such that the distance D2 is
a starting distance. When the patient support is moved into an
upwardly breaking position (FIG. 49) or a downwardly breaking
position (FIG. 51), and possibly a Trendelenburg position (FIG.
50), or a reverse-Trendelenburg position (not shown), the
translation connector 648 is passively moved away from the pier 606
such that D2 is reduced relative to the starting distance. When the
patient support 610 is returned to the initial planar position that
is parallel with the floor, the translation connector 648 is
passively moved back toward the starting position, and D2 is
increased. Changes in the distance D2, or translation compensation,
are in response to coordinated movements and positioning of the
patient support 610. The amount of change in D2 is coordinated with
the breaking of the hinges 616 and movement of other portions of
the apparatus 601, such as by synchronizing electronics and a
controller, such as but not limited to controller 618.
[0136] The patient support 610 is sized and shaped to reversibly
receive thereon and engage a body support structure. Generally,
numerous body support structures are attached to or fixed to the
frames portions 612, 614 along their lengths. Such body support
structures are know in the art and include, but are not limited to
hip-thigh pads, generally 670, chest or torso support assemblies,
generally 672, and chest or torso translation assemblies, generally
674. Detailed descriptions of several of these body support
structures can be found in U.S. patent application Ser. No.
12/803,192, filed Jun. 21, 2010, U.S. patent application Ser. No.
13/956,728, filed Aug. 1, 2013, and U.S. patent application Ser.
No. 14/012,434, filed Aug. 28, 2013, each of which is incorporated
by reference herein in its entirety.
[0137] The hip-thigh pads 670 are generally attached adjacent to
the hinges 616. In some embodiments, the hip-thigh pads 670 are
incorporated into or include the hinges 616. The placement of the
upper body supports depends upon the location of the hip-thigh pads
670 and the length of the patient's spine. Generally, it is
desirable to maintain a substantially constant distance D3 (see
FIG. 48) between the patient's hips, or the hip pads 670, and an
upper body support, such as the chest support 672 or torso trolley
674. Upward and downward breaking of the hinges 616 is associated
with flexion and extension, respectively, of the patient's hips.
Therefore, keeping distance D3 substantially constant
advantageously prevents excessive, or undesirable, pulling and
compression of the patient's spine during upward and downward
breaking of the hinges 616.
[0138] In some embodiments, such as is shown in FIGS. 48-51, both
the hip-thigh pads 670 and the upper body support are located on
the same side of the hinges 616. For example, the hip-thigh pads
670 and the upper body support may be attached to the frame portion
614. Accordingly, since the hip-thigh pads 670 are stationary, it
is acceptable to support the patient's upper body with a stationary
upper body support, such as the chest support 672, which is fixed
to and locks onto the frame 614.
[0139] In other embodiments, the hip-thigh pads 670 and the upper
body support are located on the opposite side of the hinges 616, or
the hinges 616 include the hip-thigh pads. For example, as shown in
FIG. 53, the hip-thigh pads 670 are attached to the frame 612 such
that they are located adjacent to the hinges 616, and the torso
trolley 674 is attached to the frame 614. The torso trolley 674
includes upper body support portion 676 and an actuator 678. The
actuator 678 moves the upper body support portion 676
longitudinally, as is indicated by the arrow 680, so as to maintain
the distance D3 substantially constant. Movement of upper body
support portion 676 by the actuator 678 is coordinated, or
synchronized, with the movements of the hinges 616 by software and
a controller, such as but not limited to controller 618.
[0140] Thus, if the hip-thigh pads 670 are located on the opposite
side of the hinges 616 from the upper body support, and the upper
body support is stationary, the distance D3 will vary (i.e.,
increase and decrease) during actuation of the hinges 616. However,
if the upper body support is longitudinally movable, such as is the
torso trolley 674, the upper body support can move longitudinally
along the frame 614 at a suitable rate and in a direction that is
sufficient to keep the distance D3 substantially constant. For
example, when the frame 610 is in a planar configuration, the torso
trolley 674 is attached to the frame 614 at a location along the
length of the frame 614, such that the upper body support portion
676 is spaced an initial distance of D3 from the hip-thigh pads
670. When the hinges 616 are actuated and moved to an upwardly or
downwardly breaking position or configuration, the hip-thigh pads
670 swing away from their initial position. If the upper body
support is stationary, like the chest support 672, the distance D3
would be increased. The torso trolley 674 avoids this problem,
because as the hip-thigh pads 670 swing away from their initial
position, the actuator 678 of the torso trolley 674 moves the body
support 676 toward the hinges 616. The body support 676 is moved at
a rate sufficient to keep the distance D3 substantially constant,
and such movement is coordinated and synchronized with the
movements of the hinges 616. When the hinges 616 are moved back to
their starting position, wherein the patient support 610 is planar,
the hip-thigh pads 670 swing back toward their initial position.
Simultaneously, the actuator 678 moves the upper body support 676
away from the hinges 616 at a rate sufficient to keep the distance
D3 substantially constant.
[0141] It is noted that the components of the apparatus 601
cooperate, or work in concert, perform several functions at the
same time, so as to move or place a patient's body in a desirable
position for performing the surgical procedure. These functions
include, but are not limited to, simultaneously maintaining the
surgical site at a substantially constant height H, maintaining the
surgical site at a substantially constant location along
longitudinal axis of the apparatus 601, and enabling or allowing
movement and positioning of the patient's body during the surgical
procedure, such as (but not limited to) by upward and downward
breaking, inclination and tilting of the patient support 610.
[0142] It is noted that providing for translation of the patient
support 610 at both outer ends thereof, such as is provided by the
second base 617, and the translation connector 648 and angulation
subassembly 267 enables the hinges 616 to be substantially
stationary in a longitudinal direction, such that the hinges 616 do
not move substantially toward either the operating table support
structure 604 or the pier 606. Preventing the hinges 616 from
moving longitudinally substantially prevents the surgical site, on
the patient, from moving longitudinally toward either end of the
apparatus 601. Many surgeries are performed under magnification
and/or in conjunction with continuous imaging of the surgical site.
As is known in the art, even small movements of the surgical site
parallel with the longitudinal axis of the apparatus 601 is
substantially disruptive of such surgical procedures. Accordingly,
longitudinal translation at both ends of the apparatus 1 provides
significant advantages over surgical tables that include such
longitudinal translation at only one end thereof.
[0143] It is to be understood that while certain forms of the
present invention have been illustrated and described herein, it is
not to be limited to the specific forms or arrangement of parts
described and shown.
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